Colorectal cancer, also known as colon cancer, is a type of cancer in which there is cancerous growth in the colon, rectum, or appendix. It is the fourth most commonly observed form of cancer. Approximately 70% to 80% of colorectal cancer occurs among people at average risk, which is defined as any individual who is not categorized as being at high risk. Consequently, it is always suggested to undergo a total colonoscopy once every ten years for all people above fifty years of age.
Colonoscopy—an endoscopic examination of the colon and a portion of the small intestine—is an important medical procedure in diagnosing colorectal disorders. Medical professionals need to have sufficient training to gain expertise. In the United States, the American Society for Gastrointestinal Endoscopy (ASGE) suggests a minimum of 100 colonoscopies be performed by medical students to acquire proficiency, and it is considered that most students require more than this number. When medical students are trained, this training is usually associated with long procedure times causing discomfort to each patient and further complicating the procedure.
In the last twenty years, a number of simulators have been developed to aid in training students by practicing the procedure in a controlled and safe environment. Due to constraints in educational funds, time, patient availability, and an increasing patient awareness in the medical field, large scale use of simulators is necessary in training and educating medical students. It is predicted that with further technological advancements, practice on simulators will become a requisite before actual practice.
Conventional colonoscopy training models may be categorized as visual part based on virtual reality, visual part with a feedback mechanism, and ex vivo simulator including a portion of animal or mechanical model. The ex vivo simulator may include a bovine colon with a hard cover surrounding and confining the ex vivo bovine colon. However, the hard cover reduces visual feedback that the trainee may otherwise acquire reaching specific landmarks within the bovine colon. The main function of the ex vivo model is to improve intubation skill and multiple parameter control.
Conventional virtual reality-based colonoscopy simulators include one or more graphics displayed on the screen to enhance the effect of the colonoscopy training. One such model, the GI Mentor (Simbionix, Lod, Israel), includes a flexible endoscopy simulator used with a kind of virtual reality simulator that is suitable for employing various scenarios. Still another virtual reality simulator is the GI Mentor II computer system. However, the GI Mentor series is very expensive and not all the test assessments are satisfied by the users.
While virtual reality simulation may be used to improve the trainee's skill and performance, virtual reality may also be used to enhance the current training quality and improve patient safety.
However, computer simulation alone is not helpful in enhancing the training effect. Therefore, some colonoscopy simulators incorporate electrical motors with encoders to generate tactile feedback effects that parallel the displays on the screen. Realistic feedback to the shaft of the colonoscope is one of the keys to validating the learning curve of, for example, the commercially-available HT Immersion Medical Colonoscopy Simulator (Immersion Medical, Inc., San Jose, Calif.).
Most conventional colonoscopy simulators measure partial outcomes, such as intubation skills including, for example, the ability to reach the cecum or to escape a loop problem (which is when the distal tip end of the colonoscope turns and advances out of the colon rather than further advancing within the colon) or differentiation of skill level (i.e., novice/intermediate/expert). However, there remains a need for a simulator and/or training system that provides comprehensive feedback in a realistic surgical environment.